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Monday, November 26, 2012

AIDS Free Africa is Possible

An estimated 34.2 million people around the world are infected with the virus that causes AIDS, H.I.V. The scary part, what is disconcerting is that 23.5 million or 70% of those suffering from AIDS live in my part of the world, sub-Saharan Africa.

There is no prospect that scientists will find, any time soon, a vaccine that will prevent infection with the AIDS virus or a cure for our brothers and sisters, mothers and fathers, uncles and aunts, husbands and wives, friends and neighbors already infected with the virus.

But today our spirits must continue to soar. Our collective will must be indomitable. Our embrace of the gift of life has never been stronger. The vision of attaining zero new HIV infections and zero AID-related deaths remains the collective resolve of all of us.

It is possible that in the not too distant future, no African child would be born with the AIDS virus. I have a dream that one day millions of African teenagers and young adults, heterosexual and homosexual, would have a very low risk of becoming infected and those who do would have access to affordable treatment.  Achieving an AIDS-free Africa is truly imminent. We can and we must get there.

Here is why we will get there. Historic success in scaling up HIV programmes, combined with the emergence of powerful new tools to prevent new infections and AIDS-related morbidity and mortality has enabled the foundation to be laid for zero new HIV infections.  We are beginning to reap the benefits many years of concerted work and multiple strategies: behavior change campaigns; promotion and use of condoms; medical male circumcision; access to antiretroviral therapy; and, focused programs targeting sex works, gay or straight. 

According to the just released UNAIDS report on the global AIDS epidemic, new infection rates have fallen by 50% or more in 25 countries – 13 of them in in sub-Saharan Africa. Moreover, the number of people dying from AIDS-related causes in sub-Saharan Africa declined by 32% from 2005 to 2011. What is most heartening is that half of all the reductions in HIV infections in the past two years have been among children. The scaling up of antiretroviral therapy has saved 14 million life-years in low-middle-income countries, including 9 million in sub-Saharan Africa since 1995. The pace of progress has accelerated. In just two years, 60% more people have accessed lifesaving HIV therapy, with a corresponding drop in mortality.

In what has been billed as a scientific breakthrough, scientists have shown that antiretroviral therapy reduced the risk of heterosexual transmission by 96%. Today treatment as prevention (TASP) is a term used to describe prevention methods using antiretroviral treatment. An HIV-positive person’s viral load is the single biggest risk factor in HIV transmission. Antiretroviral therapy decreases the amount of virus in a person’s bodily fluids, significantly reducing the risk of transmission.
Circumcision substantially decreases a man’s risk of becoming infected with the AIDS virus by a female partner, cutting infection rates by 40 to 60 percent. In Kenya medical male circumcision in Kenya is focused on Nyanza Province. 54% of the targeted 230 000 male circumcisions have been performed as of December 2011. As a medical procedure circumcision is simple. A nurse can perform it safely and it can be done in assembly-line fashion using devices that do not require scalpels and stitches.
Although progress is heartening, the war against AIDS is yet to won. The sharp reduction of AIDS in Uganda was hailed as a stellar success reduction, providing a new impetus and inspiring novel public health strategies to fight disease in the developing world. Today, Uganda is one of only two African countries, along with Chad, where AIDS rates are on the rise. Infection rates in Uganda have increased to 7.3 percent today from 6.4 percent in 2005. Furthermore, Uganda is one of in six sub-Saharan African countries where less than 5% of the target number of men had been circumcised by 2011.

According to the UNAIDS report on the global AIDS epidemic, HIV affect more women and girls across sub-Saharan Africa. It is estimated that women represent about 58% of people living with HIV.  More significantly, because of social and economic power imbalances between men and women, a majority of girls and women and girls have little capacity to negotiate sex, insist on condom use or otherwise take steps to protect themselves from HIV.

The UNAIDS report on the global AIDS epidemic provides specific recommendations critical to the goal of zero new infections: provide HIV testing, counseling; ensure timely HIV care, treatment and support for women an children living with HIV; strengthen safe sex behavior to ensure that reproductive-age women and their partners avoid HIV infection. 

Saturday, November 17, 2012

Trade Not Universal Cure For Africa’s Chronic Hunger

The lion economies are on the prowl. McKinsey Global Institute, a business think tank, shows that sub-Saharan Africa’s real GDP growth rate jumped to an annual average of 5.7%, up from only 2.4% over the previous two decades.
However, impressive GDP growth rates in Africa have had no impact on Africa’s chronic hunger and malnutrition. According to the first Africa Human Development Report by UNDP, over 200 million Africans are undernourished and one third of Africa’s children are stunted. Africa’s chronic hunger and malnutrition impairs livelihoods, undermines human development and creates intergenerational poverty traps.
The US, the world’s largest exporter of maize and wheat, is facing the most severe drought in 50 years. Similarly, severe weather has also visited havoc in other major grain exporting countries like Australia, Brazil, Russia and India. Consequently, global food prices hade jumped 6%, with price of maize going up 23%.
Rising food prices is bad for Africa’s poor households who spend over 50% of their earnings on food. Similarly, rising food prices have severe impacts on Africa’s trade balance because only 5% of food imports come from within Africa. Moreover, Africa’s food imports are projected to double by 2020 hence the macroeconomic impacts of food importation will only get worse.
Africa’s chronic hunger, the rise in global food prices and the ever-growing food import bill has turned global attention to Africa’s agriculture and food policies. In a recent report, “Africa Can Help Africa”, the World Bank argues that increased regional trade has the potential to: expand the regional market for food staples; boost agricultural production in surplus zones; and, ameliorate price volatility, improve national and regional food security.

Agricultural potential is not equitably allocated within and among countries. Africa has traditional areas of food deficit and food surplus. Drought prone areas, such as the Horn of Africa and the Sahel often experience crop failure. Highly productive agricultural zones such as Eastern Uganda, Northern Zambia, Southern Mali, and Southern Tanzania are food surplus areas.

Given the differences in weather patterns across countries, regional food production tends to be less variable than production at the country level. Moreover, seasonal variability in rainfall and production, which will increase with climate change, is not limited to national borders. The World Bank argues, rightly, that an Africa food security model based on national self-sufficiency goals alone cannot work.

The report, Africa Can Help Africa, offers four messages worthy of careful reflection:
1.     Removing regional trade barriers offers benefits to farmers, consumers and the economy. Farmers gain incentives to increase production to supply expanded markets. Consumers benefit from reduced price volatility and improved access to food. Local and regional economies benefit from jobs created by the value chains created through labor markets, input supply markets, storage and distribution, including transportation and financial services;
2.     Remove regulatory barriers to trade and competition along the farm to fork value chain. Trade barriers deny African farmers access to higher yielding seeds and better fertilizers available elsewhere in the world. What is needed is a consistent and stable policy regime to regulate trade in agricultural inputs as well as enabling the creation of public-private partnership that reduce the transaction costs of coordination failures and information asymmetry across the value chain;
3.     Build and reform institutions that guarantee market stability and efficiency.  The primary objective is to support informational and distribution functions of food markets. In this regard, commodity exchange and warehouse receipts are essential. Weather-indexed insurance can lessen the impacts of climatic shocks on farmers. The idea is that if rainfall or critical climate parameter falls below a certain threshold, a farmer would receive compensation for production losses;
4.     Political economy issues that constrain open regional trade must be addressed. Commitments to opening up regional trade in food, implementation has generally been weak.  Opening up agricultural and food staples to regional trade will inevitably create winners and losers. Where reform reduces the gap between producer and consumer prices, farmers and poor consumers will gain; middlemen and political rent seekers will lose. Hence, governments must explain the benefits of a regional approach to food security and build political and social consensus for integrated agricultural markets.

It is not uncharacteristic of the World Bank to propose a classical neoliberal market approach to dealing with Africa’s chronic food insecurity. In our quest to solve problems we often get trapped in a linear construct, which leads inevitably to non-integrated and limited solutions. Cross border trade must be part of an ecosystem of solution options, including attracting Africa’s youth to agriculture, adaptation to climate change and careful stewardship and monitoring of natural capital (e.g., soil, water, pollinators) critical to sustainable agriculture. Complex problems abhor simplistic approaches.

Saturday, November 10, 2012

Eradicating Malaria in Africa Demands Integrated Strategies

Malaria kills 1.2 million people each year, according to new research and published in the British medical journal the Lancet in February 2012. This is more than twice as many deaths as reported by the World Malaria Report published in 2011.

 This research conducted by the Institute of Health Metrics and Evaluation also found that while many believe most malaria deaths occur in children under age 5, 42% of all malaria deaths occur in older children and adults. Malaria is caused by a parasite passed to humans through mosquito bites. The parasites then travel through the bloodstream to the liver and infect red blood cells. If left untreated, complications can include kidney failure, liver failure, meningitis and, ultimately, death.

 According to WHO, 81% – 174 million out of 216 million cases of malaria world wide – occurred in Africa. Moreover, malaria is the cause of 1 in 5 childhood deaths in Africa. Jeffery Sachs, the world’s foremost scholar of sustainable development and Director of Columbia University’s Earth Institute, has shown that global distribution of per-capita gross domestic product has a striking correlation with malaria and poverty. In a paper published in the journal Nature in 2002, Sachs concluded that where malaria prospers, human societies have prospered the least.  

The direct impact of malaria on household income and nutrition in Africa has been demonstrated. For instance, in Ivory Coast, farmers suffering from malaria for more than two days out of a growing season had 47% lower yields and 53% lower revenues than their neighbors who missed no more than two days.

Scientists have shown that malaria may be accelerating the spread of HIV in areas of sub-Saharan Africa where there is a substantial overlap between the two diseases. The viral load of a HIV-infected person increases ten-fold during an attack of malaria. This is because the immune system's response to the malarial parasite produces proteins called cytokines, which have the perverse effect of encouraging HIV to replicate. This is according to a study published in Science in 2006 by Laith Abu-Raddad of the University of Washington, in Seattle, and his colleagues.

International funding for malaria control increased sharply over the last decade, reaching US$1.5 billion in 2009. Increased global funding resulted in robust expansion of antimalarial programs: rapid scale-up of distribution of insecticide-treated mosquito nets – reaching 76% of the population at risk; expansion of indoor residual spaying, reaching 13 million in 2005 to 75 million in 2009; increase in the use of rapid diagnostic test, prior to treatment, for all patients with suspected malaria from less than 5% at the start of the decade to 35% in 2009.

But new commitments for antimalarial programs have stalled, falling short of the estimated US$6 billion needed from 2010 going forward. This is especially worrying because progress and gains against malaria remain fragile in a majority of high-risk malaria countries in Africa.

The stalling of funding for antimalarial programs is especially troubling in Africa for the following reasons: decline in government health budgets and weakening of population health systems; expansion of rural and urban populations to malaria prone areas; expansion of agriculture through building dams and irrigation schemes; changes in mosquito ecology owing to deforestation and effects of global warming such as increased frequency of El Nino events.

A vaccine against malaria, like a HIV vaccine, remains elusive goal. At a vaccine conference in Cape Town November 8, 2012 GlaxoSmithKline revealed at a cost of USD $300 million, clinical trial of their vaccine Mosquirix proffered only 31% and 37% protection against malaria for infants and adults respectively. With Funding from Bill & Melinda Gates Foundation, PATH Malaria Vaccine Initiative has committed more than USD$200 million into vaccine development.

To deal robustly with malaria, Africa must look beyond drug therapy, insecticides and vaccines. New strategies for malaria control and prevention must deploy integrated malaria management. This approach could deliver cost effective malaria control benefit while minimizing effects such as bioaccumulation of toxic chemicals and drug resistance.

Integrated malaria management solutions include flexible and adaptive management of ecological, environmental, hydrological conditions and knowledge of patterns of malaria transmission, and human settlement planning, which: improve management of reservoirs and irrigation systems; eradicate vector larvae through biological control; reduce vector breeding sites; locate human settlement away from corrals and potential mosquito breeding sites; and, better housing design and construction.

Integrated solution work. Studies have shown that the cost of environmental management for malaria in copper mining communities in Zambia is lower than the cost of control programs that utilize insecticides and chemoprophylaxis implemented in countries like South Africa and Kenya.

For Africa integrated vector management, which provides effective control of the malaria without reliance on any single intervention while delivering cost-effectiveness and sustainability, is the sensible policy approach.   

Tuesday, November 6, 2012

The Big Check

A privately funded campaign is has narrowed in on a tool for helping men to gauge their obesity. When standing upright, can they see their penis?
After funding their own survey of 1,000 British men, the health advocacy group found that "33 percent of men in Britain aged between 35 and 60 years are unable to see their penis" because of their bellies. They presumably controlled for poor vision.
Dubbed "The Big Check," the campaign is based on the simple idea that men may be flippant about the health risks of belly fat, but anything concerning their junk is likely to get their attention.
According to the group's staff expert, "Men care more about maintaining their cars than their own bodies, and often only see the doctor if told to by a female partner or relative." Dr. Sarah includes helpful tips on how woman can shoulder the responsibility for their guy's health, which, aside from one "sexy" suggestion ("encourage him to check his testicles regularly for lumps -- or check them yourself as part of foreplay") are mostly just variations on nagging.
Dr. Sarah's apparent lack of faith in men being able to do anything for their own health comes off far from progressive. But as long as we're throwing the kitchen sink at the obesity epidemic, I can think of worse ways of going about it.

Story carried in The Atlantic Health

Sunday, November 4, 2012

High-Stakes Testing Killing Kenya’s Education

According to a report of the Kenya National Bureau of Statistics, Kenya Facts and Figures 2012, the Gross Enrollment Ratio (GER) in primary school was 115% in 2011. However, at 48.5%, the GER in secondary school was markedly lower than in primary school.

In real numbers, 9.85 million children were enrolled in primary school compared to the 1.8 million in enrolled in secondary school. Similarly, only 133000 and 198000 students were enrolled in middle level colleges and universities respectively in 2011. Why is progress in education so perilous for most of our children? Why is the quest for education associated with such a massive and unconscionable ruin of human potential? Are our children really incapable of high education attainment?

The catastrophic waste of human potential seems inexplicable until one accounts the outsized faith we have put on examinations. Our children are victims of high-stakes national examinations.

Thinking about the exam-centric education system reminds me of the logic of colonialism. The hegemony of the colonial state was advanced through the authority and tyranny of the settler minority with the support of a handful educated native acolytes. The raison d'être of education in the colonies was to cultivate a cadre of well-selected native acolytes capable of imitation and unquestioning execution at the behest of the colonial state.

Today, the Kenyan education system is centred on the authority of the curricular and the tyranny of high-stakes national examinations. The fact-laden curricular is sacrosanct; students have no chance to co-create or discover knowledge. Moreover, the oracular authority of the curricular and its high priest, the teacher annihilates the innate explanatory and logic paradigm for understanding the world, which young learners have.

The standardized national examinations have a tyrannical hold on students, teachers and parents. My high school headmaster referred to exams as a “necessary evil”. Evil from which we need divine deliverance. Weeks and days before the national examinations, students, teachers and parents congregate on bended knees to seek divine intervention.

Like every sphere of Kenya’s public life, the administration of examinations is plagued by maleficence. We know that parents, teachers and students collude to game examination outcomes. It is common knowledge that you could purchase examination papers for your children or students. A friend once told me that the national exam questions in the four A-level subjects he took were the same questions in their final school mock examinations.

Our exam-centric education system, especially the high stakes standardized examination, is the biggest purveyor of inequality in our country today. Winners and losers in our exam-centric education system map neatly along the fault lines of structural inequality, poverty and privilege in our country. Our education system fails hundreds of thousands of children from poor urban and rural families, who attend primary schools without adequate teaching and learning resources.

Conversely, our education system privileges a small minority of children who attend well-resourced urban public and private primary schools. Invariably, a large majority of these children make the grades to attend elite public secondary schools, pedigree that guarantees admission into undergraduate degree programs, which lead inevitably to prestigious professions.

For the massive outlay of public resources, 13.5% of the national budget, our education accomplishes far less for our children and society. Beyond memorization and regurgitation for the high-stakes national examinations, our education asks little of our children and teachers. In a majority of schools teachers are not focusing on teaching and learning, but on raising the mean grade in their respective subjects. As a consequence, our education has largely failed to develop the critical attributes of a competitive knowledge worker in a globalized world.

A recent report by Uwezo, a civil society group that monitors educational achievement, revealed that a majority of students complete primary school without being able to read or write or add. Similarly, there are increasing concerns about the state of undergraduate and graduate education. A majority of graduates our universities cannot write well and have no capacity for critical thinking and complex reasoning.

The national high stakes testing betrays an unnerving incapacity to re-imagine and re-create an education system that serves the urgent needs of a dynamic 21st century society. Given that the etiology of the dysfunction of our education system is founded in our colonial heritage and is deeply rooted in vested interests and political economy of the modern Kenyan state, bringing reforms to Kenya’s education system is akin to moving a cemetery.

Despite the drawbacks of our education system educators, from kindergarten to university,  unanimously agree that developing students’ capacities to think critically, intuitively, ensuring that they become adept at analytical and logical reasoning is the ultimate goal of education. More than facts and a high mean grade or grade point average, these capacities are the foundation for effective citizenship, civic leadership and economic productivity. 


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